ERS Handbook of Respiratory Sleep Medicine

Neurobiology and physiology of sleep and breathing. Definitions of sleep disordered breathing. More specific grading of sleep disordered breathing. Evaluation of obstructive sleep apnoea severity. Epidemiology of obstructive sleep apnoea, central sleep apnoea and hypoventilation syndromes. The pathophysiological concept of upper airway obstruction, the arousal threshold, muscle responsiveness and respiratory drive. Pathophysiology of central sleep apnoea. Pathophysiology of hypoventilation. Clinical aspects and consequences of sleep disordered breathing: obstructive sleep apnoea. Clinical aspects and consequences of sleep disordered breathing: central sleep apnoea. Clinical assessment: sleep history. Questionnaires in respiratory sleep medicine. Clinical examination. Clinical assessment: comorbidities. Identification of high-risk patients. Methods of different sleep tests. Limitations of oximetry and respiratory polygraphy in comparison with hospital-based PSG studies. Nocturnal capnography. Assessment of excessive daytime sleepiness. Diagnostic algorithms based on an individualised patient approach. Screening with limited sleep tests to increase pre-test probability. Non-continuous positive airway pressure therapies. Indications for continuous positive airway therapy. Differences between fixed-level CPAP, variable (automatic) CPAP and BPAP. Side-effects associated with continuous positive airway pressure. Adherence to continuous positive airway pressure treatment. Monitoring positive airway pressure therapy. Evaluation of positive airway pressure efficacy. Prognostic impact of central sleep apnoea. Management: central sleep apnoea in chronic heart failure. Management: continuous positive airway pressure or adaptive servo ventilation in patients with opioid-induced sleep disordered breathing. Treatment of central sleep apnoea with oxygen, drugs and phrenic nerve stimulation. Treatment-emergent CSA, idiopathic CSA, high-altitude periodic breathing and CSA in non-cardiac medical neurological conditions. Sleep disordered breathing in patients with other disorders. Sleep disordered breathing in patients with other disorders : asthma, chronic obstructive pulmonary disease and interstitial lung diseases. Sleep disordered breathing in patients with other disorders: diabetes and metabolic syndrome. Sleep disordered breathing in patients with other disorders: hypothyroidism and acromegaly. Obesity hypoventilation syndrome. Disorders that cause respiratory failure. Assessment of respiratory muscle weakness. Symptoms and signs of ventilation. Peri-operative assessment and management of pregnancy. Treatment of hypoventilation syndromes: noninvasive ventilation. Treatment of hypoventilation syndromes: indications for tracheostomy. Treatment of hypoventilation syndromes: cough augmentation techniques. Treatment of hypoventilation syndromes: indications for additional oxygen treatment. Treatment of hypoventilation syndromes: palliation and advance directives in end-stage disease. Non-respiratory sleep disorders: identifying which patients to refer for further investigation. Non-respiratory sleep disorders: insomnia. Non-respiratory sleep disorders: restless legs syndrome. Non-respiratory sleep disorders: narcolepsy and idiopathic hypersomnia. Non-respiratory sleep disorders: parasomnia and associated conditions. Non-respiratory sleep disorders: circadian disorders. The medico-legal and socioeconomic impact of respiratory sleep disorders. Organisational aspects in sleep clinics. Emerging technologies to monitor sleep and circadian rhythms. New digital diagnostic tools for respiratory sleep disorders. Digital health innovations for optimisation and follow-up of therapy. Big data and artificial intelligence: opportunities and challenges. Patient empowerment/participation in care of respiratory sleep disorders. Development of breathing and sleep, and pathophysiology of apnoea in the first years of life. Sleep disordered breathing in children. Comorbid respiratory disorders in children. Clinical assessment and diagnostic techniques in children. Management of sleep-related respiratory disorders in children.